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Country Comparison: A US hospital birth experience for an Irish first time mother

I was born, raised, and lived the first twenty-nine-and-a-half years of my life in Dublin. But, as it tends to do, life took me elsewhere and three years later I found myself living in the very southmost tip of Texas, about to have a baby with my also-Dubliner husband. Before I was pregnant I always assumed I’d have an epidural when I had my babies, just as – as far as I knew – everyone did these days. But as time went on, I began to read pregnancy blogs and listen to friends who’d gone before, and it seemed suspiciously as if the pattern for many first-time mothers these days – in Ireland and America – went more like: two weeks overdue, induction, long hard labour resulting in emergency C-section. This seemed less than ideal. Then a friend gave me a copy of Henci Goer’s The Thinking Woman’s Guide to a Better Birth, I read it, and I was quite annoyed. “Well,” I told her, “now I have to go and find a midwife and try to have a natural or low-intervention birth, I suppose. I sort of wish I hadn’t read that.”

But you can’t unknow what you know, and as a self-professed thinking woman, I owed it to myself and Henci – and my unborn baby – to at least try to buck the trend and aim for a more natural birth. I am far from a hippie – at least, in those days I thought I was – but everything I was reading made it clear that I should look for a midwife. The area of Texas we lived in was overwhelmingly Hispanic, so I was clearly a fish out of water as soon as you looked at my pale Irish skin. I was prepared to play the crazy foreigner card once more to try to get a birth I was happy with.

My GP – an elderly woman – assumed I would go to the local hospital and was surprisingly dismissive about birth centres when I asked her. “That’s just for the poor people,” she said, and gave me the name of an OB/GYN to call. I immediately lost that number and did some research for myself. I looked into getting a doula, but there were none in that part of the country. I called the local La Leche League rep, left a message, and never got a response. But then I got a lead – I phoned the only birth centre I could find in the area – still a good two hour’s drive away – and they told me that they worked with a midwife who was based with an OB/GYN practice in the town just half an hour up the road from mine, and who delivered at the hospitals in town most of the time. She was highly recommended, and so that was my next port of call.

And thus I found my midwife. She was a tiny woman reminiscent of Edna Mode in The Incredibles: all four foot nothing of her brimming with authority and inspiring confidence. I loved her and I was lucky to have found her in an economically-depressed part of the country where trendy baby-wearing and hipster natural birthing are far removed from the day-to-day struggles of the majority.

What follows is a (slightly) edited version of the birth story I wrote for my blog in May 2006.

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My nine-day old son (my son!) is asleep in the other room, wrapped up like a little parcel in a blue blanket, wearing the hat with the pom-pom that they gave us in the hospital. His eyes are scrunched up and a tiny wrinkle persists at the top of his nose, and it’s time for me to start telling this story. Every day the story grows with the boy, and if I don’t start soon I’ll have a book’s worth: the same book that every new mother would write, but it’s all new to me.

“You’re from Ireland, aren’t you?” he said. “This came from there, you know.” He was talking about active management of labour, the brainchild of Dublin doctors in the 70s, and bane of the lives of midwives and other natural childbirth proponents. “That doesn’t mean it’s a good idea,” I parried weakly as he disappeared into the far reaches of the hospital corridors.

The weekend before last I was 38 weeks pregnant and my husband, B, was at a conference in Dallas, a mere two-flight hop away and within reach of any emergency phone calls. Of course there wouldn’t be any emergencies and he’d be back on Monday evening to the loving arms of his still-pregnant wife and the orderly home of the pre-baby era. I had a friend and neighbour lined up to be on call just in case anything should happen, and I spent the weekend alternately being efficient and taking it easy. On Saturday I treated myself to my long-awaited end-of-pregnancy pedicure. My little fat feet were so swollen that all the girls in the salon exclaimed over them. Everyone marvelled at our self-restraint in not finding out the sex of our baby beforehand. Like most of the town, they assessed my all-out-in-front shape and decided it was a boy anyway.

At 2.00 am on Sunday night – that is, Monday morning – a “flub” of liquid in my nether regions woke me. I knew what it was straight away – this was no ambiguous trickle – and cursed the gods of irony, or hubris, or whatever it was that had led me to think I’d get away with sending my husband to a conference at 38 weeks pregnant. I jumped up to try to save the mattress, ran to the bathroom and ministered to myself as much as I could, given that it just kept coming. I had already stocked up on jumbo-size pads for after the birth, and while woefully inadequate, it was the best I could do. All hyped up, I draped a towel over the chair beside the phone, sat down, and rang my midwife.

Vivian’s phone went to voicemail. I left a message and then had to ring back with another to leave my mobile phone number, which I can never remember. I thought it was a fairly calm and collected message, all things considered. I knew she’d been away for the weekend too, in San Antonio, but was pretty sure she had come back the previous evening. Small mercies. Next to call was the clinic – I was certain they’d tell me to go straight to the hospital, but I had to ring and find out. The person on call said they’d get Dr T to ring me back. Okay. I knew I had plenty of time, really, except for all the messiness emanating from me, so I left the calls at that for the time being.

About 15 minutes later I heard from the Dr T, who said yes, I should go to the hospital. That was that, and Maria – friend, neighbour, husband’s co-worker extraordinaire – was summoned. On the first ring her phone disconnected, and as I re-dialled my mind played over a brief scenario where I called a taxi, or even an ambulance, because (a) I wasn’t sure which apartment number was hers, even though it was a thirty-second walk away, and (b) she wouldn’t hear my knocking from her bedroom anyway – none of the apartments have doorbells. The second time she answered, sounding alert and prepared for anything – especially exactly what I said: “Maria, I’m really sorry to wake you but my waters have broken and I have to go to the hospital.” She was on the doorstep in about a minute.

Before she arrived I made my final call. I’d let B sleep as long as I could and it was time to wake him up. I knew that once I did he’d never go back to sleep, out there in an anonymous hotel room in the far-off metropolis of Dallas, but on the other hand, I couldn’t exactly not tell him. He answered his phone sleepily.

“Hello?”

“Guess what? My waters have broken.”

He was incredulous, and I was giddy. He said he’d get straight on to finding new flights as early as possible, we exchanged mutual “Oh wow”s, and then Maria was at the door, picking up my bag full of new pyjamas I didn’t get to use, ridiculously tiny white baby clothes, sundry massage implements, and a big blue bottle of Gatorade; the “birthing” ball (otherwise known as a plain old rubber exercise ball); and my waterproof-pillow-cased extra pillow.

The baby’s heartbeat was perfect the whole time – Linda said it was magnificent and that if all the babies were like mine her job would be a lot less stressful. I smiled smugly because of course our baby was perfect.

Later I found out that, as I suspected, Vivian would probably have told me to stay put and not go to the hospital till morning. She apologised profusely for having switched off her phone, the quicker to charge it when she got back from her weekend away, and said she’d have asked me about the colour of the fluid – to make sure there was no meconium in it – and whether I felt anything in my vagina which could have been a prolapsed umbilical cord, and assuming that was all okay – which it would have been, she would have said to stay at home, try to sleep, have a nice digestible breakfast of oatmeal or cereal, and come in when the daytime nurses had started their shift. However, on the whole and given the absence of spouse, I was happy enough to go in straight away and mess up someone else’s sheets instead of my own.

As we bowled down the empty highway at 2.45 or so, Maria apologised for having cut me off the first time I rang. She’d set the alarm on her phone to wake her at 7.30. When it rang the first time, she sleepily looked at the time, thought “Stupid phone,” and turned it off. Then, deep in the recesses of her mind, something registered that it had been the phone ring not the alarm sound, and that there was, just possibly, one person who might be calling her at this time of the morning. Luckily for me. She regaled me with tales of her daughter’s birth in Ecuador 14 years ago, when she started having labour pains during a bullfight. We were both giggly with excitement and missed sleep, I think, and I was only having the mildest of cramps, every now and then – nothing I would have thought twice about without the incontrovertible sign of the wetness that was even now seeping through my tracksuit bottoms, into the towel I was sitting on, and hopefully not onto Maria’s passenger seat.

We drew up to the Emergency entrance, where I knew I had to go to get into Labour and Delivery after hours, and trailed in, bag, ball, pillow, pregnant tummy, wet trousers, Uncle Tom Cobbley and all. I think it was fairly obvious what I was there for, and I looked with pity at the people in the waiting room, who presumably had much less happy reasons for being in hospital in the middle of the night. A nice security guard took us to the L&D admittance window, and phoned the woman who should have been sitting behind the glass. After an age, she showed up and made me fill in yet more forms, despite the fact that I’d already pre-registered and had my little pink card with me to prove it. Eventually she said “Follow me through the doors”, and I hugged Maria and thanked her profusely and told her to go home and get some sleep. There was no point her waiting, as they were obviously going to keep me in now I was in their clutches.

I was ushered into a room where I looked around and tried to believe that this is where it would all happen. The night-shift nurses were nice but not hugely competent. They said that since my membranes had ruptured, they had to start an IV to give me antibiotics to prevent infection. I knew this was fairly spurious, but also par for the course given the hospital, so I tried to ask for a heparin lock, which would enable them to take out the IV if it wasn’t needed. I think they agreed, but it didn’t seem to happen that way. The sweet but very young second nurse blew out two of my veins trying to get a decent IV site before the first nurse came back and saved the third place, on my right wrist. That was almost more painful than the labour. Almost. Someone checked me and said I was 90% effaced and 1cm dilated. I’d been 70% effaced at my regular appointment earlier in the week, so that wasn’t too surprising. And I was told that Dr T was on his way, though it wasn’t till around 5.00 am that he showed up. He breezed in, told me that they’d start me on Pitocin (oxytocin) at 6am so that I could give birth within 24 hours of the membrane rupture (hospital policy), and tried to breeze straight out again.

“I really was hoping to avoid the Pitocin,” I said, mustering all my diplomatic skills.
“You’re from Ireland, aren’t you?” he said. “This came from there, you know.” He was talking about active management of labour, the brainchild of Dublin doctors in the 70s, and bane of the lives of midwives and other natural childbirth proponents.

“That doesn’t mean it’s a good idea,” I parried weakly as he disappeared into the far reaches of the hospital corridors. Given my insider knowledge of Dublin traffic and Dublin weather and Dublin house prices, I think I’m well qualified to say that its provenance doesn’t guarantee its efficiency.

I think I was under the impression that there would be less pushing involved than there actually was, so every time, I thought this might nearly be it. Lying on my side didn’t feel particularly intuitive gravity-wise, but it’s Vivian’s patented method for getting the baby where it needs to be, and it evidently works.

Happily, that was the last I saw of the good Dr T, who is perfectly nice but not the person I had chosen to see me through childbirth, though he’d examined me a couple of times when Vivian missed an appointment due to some other inconsiderate woman going into labour just when I was meant to be seen by her. At 6.00 am Nurse A was about to hook up the Pit and I was asking whether Dr T hadn’t said 6.30. Nurse B bustled in and said that Vivian had just rung and said I could have any clear liquids I wanted, could get up and move around at will, and wasn’t to be put on anything till she got there and spoke to me. Hooray – a reprieve! I broke out the blue Gatorade in celebration.

At 7.00 the nurses changed shifts and my new nurse turned out to be the lovely Linda, who I’d met when I’d been admitted briefly for pre-term labour with cramps at 35 weeks. Vivian arrived around then too, and the dynamic of nurses and midwife versus hospital policy and the doctors was really interesting to observe over the rest of the morning. Vivian said that they’d wait and see if my contractions strengthened on their own before starting the tiniest bit of Pitocin they could get away with, just to keep the doctors happy. I got up to use the bathroom and, since I was unhooked and relatively free, I took the chance to spend some time bouncing on the birthing ball, given that I’d gone to the trouble of bringing it and all.

I tried B’s phone but got no answer, and assumed correctly this was because he was on a plane and hadn’t wanted to wake me by ringing earlier. Vivian checked me again later, I suppose around 9am before they started the Pit, and said that the bouncing was definitely bringing the baby down. I resolved to do some more in a while. They put on “just a whiff” of Pit so that they could tell Dr T I was on it if he asked, but they were anxious that nothing start moving too fast before B got there. I didn’t think there was any chance of that, since the contractions were still really mild. He rang at 10.00 or so to say that he was in Houston, on his way to the second flight and that he should be with me by 11.30.

Vivian brought me some Home and Garden magazines, because the one thing I hadn’t remembered to bring was a book, and I didn’t want to turn on the TV. They weren’t very interesting, but I flicked through the pages and it passed the time. I asked was there any chance I could have some breakfast, thinking that if I had to go all day on no food I might just get weak and wobbly, which would hardly help with the pushing. Again, I knew this was strictly against hospital policy, which said nothing but ice chips for labouring mothers, but Vivian and Linda put in a request for a “non-solids” meal for me, in the hopes that I might get some oatmeal. By the time it arrived, though, it was the lunch menu rather than breakfast (in hospital in America, lunch happens at 11.00), so it was some fairly nasty and only vaguely warm creamy chicken soup, juice of some sort, and an over-sweet vanilla pudding thing. Still, I ate as much of it as I could manage because I knew the calories would stand me in good stead.

And so it went on through the morning, with the bouncing and the sitting in bed and the getting up to use the loo, and the machines intermittently bleeping and constantly thumping the baby’s heartbeat, and the feeling fairly trapped by the lines to the IV and the monitors, but that was just how it was. When I was sitting on the ball I could watch the numbers on the machine and see what my contractions were doing, but the numbers really didn’t seem to bear much relation to the strength of the contractions, so I ignored them after a while. The good thing about the monitor was that I didn’t have to time my contractions. The bad thing was the hooked-up-ness and the way the top one pressed into my tummy and was uncomfortable. The baby’s heartbeat was perfect the whole time – Linda said it was magnificent and that if all the babies were like mine her job would be a lot less stressful. I smiled smugly because of course our baby was perfect.

B arrived at 12.30. At this point the contractions were still very manageable and I would concentrate on relaxing as many muscles as I could find during each one and breathing from my diaphragm. I have no idea if it worked, but I felt virtuous about doing it for as long as I could. I tried to visualize Dr Grantly Dick-Read’s little diagram of the muscles running across the uterus that interfere with the muscles going downwards if you’re tense and afraid, and to see them relaxing. That bit probably didn’t work at all, because despite all his talk of “surges”, the contractions were pains to me. They felt just like fairly bad period pains, but with a slight edge of something different that I couldn’t put my finger on.

There was more bouncing, and as the contractions were getting stronger it felt good to move with them, to be doing something gravity-enhancing and hip-opening. By about 1.30 I had to close my eyes and stop talking with each contraction. Some time between 2.00 and 4.00 pm all the zen breathing and focusing went out the window and I was just making it through each contraction as best I could, sitting up on the bed and leaning forward into them. Vivian came back from the other hospital, where she’d just delivered two babies, announced that I was 100% effaced and “four, almost five centimetres” and said that if I liked, we could talk about my pain relief options soon. Aha, I thought. The conversation she had kept avoiding every time I tried to ask her about it during my prenatal appointments. “So, talk to me about my pain relief options,” I said.

She suggested Nubain, a narcotic, that they would put in my IV for immediate effect and also inject under my skin for relief that would last up to six hours. It would help me relax so that I could save my strength between contractions. I was a bit distressed that I was only 4 to 5 cm at this point (“almost five”, she said), and worried about transition, which is the magic 7 to 10 cm and allegedly by far the toughest part. I said I’d like some Nubain please. I knew narcotics can pass through to the baby, but mostly I trusted Vivian, was pleased not to be screaming for an epidural around now, and admittedly was somewhat too distracted by the contractions to try and remember what it was the book had said about Nubain.

I think the Nubain started around 4.30 pm. The next contraction didn’t seem any easier; I’d been hoping that some “edge” would be taken off them and it didn’t seem to be happening. I nearly complained about it, but I thought that would be rude. Then somehow it turned out that in between each contraction my eyes would close, I’d hear the conversation going on around my head, but I’d practically doze off until the next pain started up.

Around now I suppose my memory of time all starts to get crunched a bit. The contractions came and went, as did the people in the room and the chatter and the instructions, some to me and some to others. At one point Vivian said “She’s not in hard labour yet; she’s not sweating”; and then later B was mopping my brow with a damp cloth and it was noted that I was indeed in hard labour. With each contraction I’d grip the side of the bed and at some stage I registered that I was making noises of a groaning variety, and didn’t really care what anyone thought about it. They put B sitting on a stool beside me so he could hold my hand, and I tried not to crush his as hard as I was gripping the bedstead. Later on I discovered that putting out my hand on the other side and pushing out against both sides of the bed helped get through each pain. B described this as my “crucifixion pose” and said he’d been worried about the bed holding up to such mistreatment.

They left the three of us together and we whispered to each other that we had made a baby, and that was the only thing that mattered.

After x amount of time, where x is actually about an hour, maybe, though we can’t really be sure even though I wrote down the timeline as close as we could get it only a couple of days later, I heard Vivian say that I was at 10, and ask if I felt the urge to push. I must have been in a lucid between-contraction state, because I asked, “I know this is a silly question, but how will I know if I feel the urge?” She explained, as I knew in theory, that the baby would be down so far that it was pressing on my, um, whatever places it is that bowel movements press on when they need to come out, so it would feel like I needed to go to the bathroom. Okay, I thought. That’s clear. I just need to wait for that. After another contraction or two I was sick of waiting, so I decided that I probably did feel the urge to push. Probably I wasn’t making it up, but mostly I just didn’t want to be there all day having contractions and not getting this darned baby out.

So the pushing started. B sat beside me – he’d been moved to the other side so that they could do something on my left – and whispered useful exhortations like “Push, push, push” and “You’re doing great”, and mopped my brow, and Vivian told me to blow each breath out through my mouth. It all helped, and I did every time I remembered, until I forgot and somebody would remind me again, blowing out for me. Vivian put me on my side with one leg up for me to grab with my top arm.

Clearly, any semblance of modesty was past at this point, and I just kept my eyes shut and tried not to think about what sort of view anyone coming into the room would be greeted by. With each contraction I’d muster all my energy to tell them that I was going to push, or that one was coming – evidently the Nubain was still having an effect – and then I’d breathe in, hold it, and push for as long as I could. They made me push twice with each contraction, or even three times if it lasted long enough. It never felt particularly like I had to do it – I could probably have let a contraction or three pass without pushing at all – but I was impatient to get it all over with.

I think I was under the impression that there would be less pushing involved than there actually was, so every time, I thought this might nearly be it. Lying on my side didn’t feel particularly intuitive gravity-wise, but it’s Vivian’s patented method for getting the baby where it needs to be, and it evidently works. Halfway through she turned me over to the other side, which is what makes the baby twist just where it needs to in the birth canal, and then she turned me back, like a pancake to be got just right. I know I was on my left side when they started exclaiming that they could see the head appear and disappear with each push, and then with an extra big push the head didn’t go back up any more. I could feel it myself now, a thing, there, in my vagina. It was good to feel concrete proof of my progress, since I didn’t get to see anything myself. B was encouraged to look and see – my eyes were still tightly shut, but I imagined him steeling himself for the gory sight and peering over to look. He said afterwards the whole thing wasn’t as … “Gross?” “Well, yes, I was looking for a nicer word” … as he had imagined it might be.

Then everyone went to action stations around me, I felt my inner thighs and everything in the middle swabbed down with what I assume was iodine and it was clear that something was going to happen. The thing inside moved with every push, getting bigger, and I heard Vivian say I had a little tear, but I couldn’t feel anything. On the final contraction, I pushed as hard as I could and felt the proverbial ring of fire – it felt like I split all the way up to my clitoris, and I thought regretfully of it and whether I would ever get to use it again. And people said, “Open your eyes!” and I looked and saw this huge round head, with hair on it, welling up from somewhere between my thighs and I couldn’t believe it. Another push and I felt a jumble of slippery limbs come after, and then it was all over bar the shouting. I considered my options and decided that “Jesus Christ! Did that come out of me?” would be appropriate, and thus my one profanity of the labour was uttered. (I think of it more as an invocation than a profanity, though. I really did feel it was quite reasonable given everything I’d just done.)

They cleaned up the baby and put him – it was a boy, of course, and everyone laughed at the inevitability of it – on my chest. He sucked away like a champion, both sides, for quite a while and they left him as long as I wanted before they took him away to make tiny footprints and prick his heel and whatever else they did. Meanwhile the placenta was delivered and my uterus was palpated and it’s all a bit of a blur, to be honest. Vivian sewed up my tear and wouldn’t tell me how many stitches I had, since they’d melt away on their own anyway. She said it wasn’t a bad one – it didn’t go into the muscle or back too far; though on my hospital discharge sheet it says it’s second degree, which sounds quite bad to me. She anesthetised the area, though it didn’t seem to take on the left hand side and I could feel the pricks, but given the lack of contractions and the presence of a baby, nothing was too bad. At one point I was shaking uncontrollably, at another they poured what felt like a bucket of warm water over my bits and it felt wonderful. Really, what happened afterwards just isn’t important. They left the three of us together and we whispered to each other that we had made a baby, and that was the only thing that mattered.

I could write chapters more; chapters with titles like “Over-cautious paediatricians and why I dislike them”, “Nipplegate: the ouchening”, or “Jaundice and how to barbecue your baby”, but I think you’ll live without hearing those stories. Every day brings a new one – or two or three – but when my little alien baby gazes into my eyes – or somewhere in the region of my eyes, because I’m not sure he’s really focusing yet – with his big dark grey almond-shaped ones, and regards me with wonder because my face is the one he’s learning best of all, I forget how I need to get some sleep and just have to gaze back at him and wonder where on earth he could possibly have come from.

All birth stories and images featured in 42 weeks have been generously shared by members of the public in Ireland. If you would like to take part and share your story, we would love to hear from you. Get in touch through the website http://www.42weeks.ie, through Facebook at http://www.facebook.com/42weeks or follow us on Twitter at @42_weeks.